Don’t fear the FROF: The importance of financial conversations

Sometimes, new patients show up wanting to establish a relationship for maintenance care or to have a DC in place to help with any future problems.

But most of the time, a new patient comes to your office because they’re in pain. And, temporarily, the crisis may take precedence over concern about cost.

It’s not that these new patients have deeper pockets than most. They are simply struggling with an amount of discomfort or dysfunction when they come through your door so they are thinking mostly about pain relief, and less about how they’re going to pay for it.

But this honeymoon period of financial fearlessness doesn’t last. In fact, before treatment can even begin, the Financial Report of Findings (FROF) must be presented and the means of payment agreed upon. The new patient whose primary focus up to this point has been “Wow, this really hurts, can you help me?” will now understandably shift gears to, “Wow, how am I going to pay for this?” How you and your team handle the FROF is key to whether or not your new patient will be able to get both physical and financial relief—and even extend to whether that new patient will be compliant with care and payments.

Managing the money talk

Many offices face challenges because not every team member is comfortable talking about money. This is often culturally ingrained because we’re raised not to ask people how much money they make, or how much their new car cost. DCs and CAs are not bankers, debt counselors, or accountants. In other words, your (and your staff ’s) own relationship with money is also in play here.

Keep this in mind as you establish who in your practice will conduct the FROF with patients. If this critical task unavoidably falls to someone who’s not good with money talk, they’ll need to put in extra training. The CA conducting the FROF must get to a comfortable level when talking about finances, or their discomfort may communicate itself to the patient.

A thoughtful process

Money anxiety generally stems from fear of the unknown. Note that new chiropractic patients are likely to be confused about their insurance coverage, and may walk in with the assumption that their insurance company will pay for more than their policy allows. If the staff member presenting the FROF to the patient is equally shaky on insurance coverage, limitations, or options for payment to fill in the gaps, an inherently difficult conversation lies ahead for both of them.

Each person who is part of this process has their own ideas and expectations. That’s not good or bad, it’s simply a fact. The thought process of each participant in the equation might look something like the following:

Patient thinking

DC thinking

Staff thinking

I hurt

I investigate/examine

I schedule

Quick fix needed

Process to fix

I schedule

What will it take?

Set a treatment plan

Set a financial plan

I have insurance

Talk to my staff

I investigate

What does it cost?

Talk to my staff

I explain and bill

Everyone in the chart above wants the patient to feel better but, beyond this shared goal, no one has the same thinking process or holds the same expectation at the same time. This is as it should be because each person and their specific skill is needed to get the job done. Everyone must work together to keep the lines of communication open.

The patient is learning to trust the DC to address the problem and also the staff to steer them in the right direction financially and keep them on track with their treatment plan.

The FROF is one of the most important foundational pieces of the patient experience. These days, just about everyone has to adhere to a budget, and some struggle to find room for flexibility or financial surprises. It’s not unusual for patients to leave a practice after receiving a large bill several months after their treatment plan ends. It’s likely they weren’t told what to expect up front or a plan was not devised.

Bypassing preconceptions

Helping patients understand their insurance benefits can be a challenge, especially when the patient comes in with a preconceived idea of their insurance coverage based on a misunderstanding of their benefits. “The company’s insurance handbook says this is covered,” Suzy might say at work before she heads to your office. Her colleague counters with, “That’s not what I’ve been told.”

Armed with hearsay and misinformation, Suzy represents a common challenge: How to conduct the FROF when preconceptions are in play. This is your team’s opportunity to explain to the patient, based on their knowledge and their verification of benefits with the patient’s insurance company, the way the patient’s coverage or lack thereof applies to the care prescribed.

This presupposes that your staff has been trained on and is confident in their own understanding of each insurance company’s benefits as they apply to the patient in question. While there are commonalities between policies, each patient situation is unique. It pays to verify insurance benefits every single time a new patient presents or an established patient returns after any absence. Assuming you know what benefits are available can lead to your office compounding misunderstandings of insurance coverage—and that’s simply a setup for the patient to lose trust in you and your team.

A mutually aligned plan

The FROF is designed to allow staff to clearly back up the treatment plan set by the doctor with an out-of-pocket cost estimate for rendered care. During the FROF, the CA explains, using the knowledge gained during the insurance verification process and their expertise gained over time, how the patient’s insurance will work, when benefits will run out or change, the benefits of joining a discount medical plan organization (DMPO), what the estimated out-of- pocket cost will be, and how the patient can fit payments into their budget.

All of the patient’s questions, objections, and more should be answered during the FROF. Having a clear understanding of finances up front allows the patient to progress through care without worrying about what they owe. Conversely, patients often drop out of care when their financial concerns aren’t addressed from the start.

When the treatment plan, financial plan, and pre-scheduled visits are in alignment and well-explained, patients are more likely to comply with treatment recommendations (and patient retention is higher, too). Expectations are known, met, and kept, and everyone is on the same page.

The FROF, as a part of an overall core relationship management system in your practice, can go a long way toward creating a roster of patients who stay, pay, and refer.

Kathy Mills Chang, MCS-P, CCPC, is a certified medical compliance specialist and, since 1983, has been providing chiropractors with reimbursement and compliance training, advice, and tools to improve the financial performance of their practices. She leads a team of 16 at KMC University and is known as one of the profession’s foremost experts on Medicare. She or any of her team members can be contacted at 855-832-6562, info@kmcuniversity.com, or through kmcuniversity.com.